Blog Post #21: A look back on the first year of the Parent-Child Assistance Program, a project of the Social Innovation Fund

Unconditional support for the long-term

PCAP’s powerful social ROI for mothers with addictions

“The costs saved in reducing the exposure to alcohol and drugs on a baby’s brain more than pays for the Parent-Child Assistance Program,'' says Dr. Sarah Gander, clinical co-lead of New Brunswick Social Pediatrics, which is piloting the program. Along with savings in healthcare, foster care, the judicial system and other potential costs to the system are the economical, social and emotional benefits to the children and their families.

“Those cases alone justify it,” Dr. Gander says.

And PCAP’s impacts go far beyond them. Since its founding, it has worked with nearly three dozen women who experience alcohol- and substance-use during pregnancy. The individualized, in-home program is based on a very successful one founded in Washington State in the 1990s that’s since been adopted in a number of American and Canadian communities.

PCAP is supported by the Social Innovation Fund, a five-year, $10-million provincial investment in creative ways of countering generational poverty. It is managed by Living SJ.

For the women who find their way to PCAP through referrals or, increasingly, word-of-mouth, progress can be dramatic.

“One girl told me, ‘I can’t believe the changes I’ve made in just six months,’” says Holly Seale, one of three PCAP case managers. The woman found an apartment, got a full-time job and got her kids back. Another client told her counsellor, “If I didn’t have Holly/PCAP in my corner, I don’t even know where I’d be right now.”

Holly Seale, one of three PCAP Case Managers.

“The biggest thing is the importance of long-term help. It can't be a bandaid.”

- Kate Robar, PCAP Case Manager

The Parent-Child Assistance Program is an important element of the New Brunswick Social Pediatrics Research Program which is made possible through generous donations to the Saint John Regional Hospital Foundation. PCAP is one of eight projects of the Social Innovation Fund managed by Living SJ. This investment by the Province of New Brunswick of $10 million over five years supports new approaches to fight generational poverty in Saint John and involves many community partners, including the Saint John Regional Hospital Foundation.

“One girl told me, ‘I can’t believe the changes I’ve made in just six months.'”

- Holly Seale, PCAP Case Manager

Unconditional support

Every client’s path is unique, and often not a straight line to recovery. Some make great gains, then relapse. Others try to push their case managers away.

“A lot of these women burn bridges wherever they go,” says Sarah Campbell, research manager of N.B. Social Pediatrics.

But the PCAP case managers are fireproof. They will not be deterred. Clients can’t get kicked out of the program. Eventually, through persistence and creating trust, a connection is forged.

“If you’re able to build a relationship with them and they know they can count on you, they can make progress,” Holly says.

Case manager Kate Robar says many of the clients lack family and community support.

“No one has probably given her a hug and said ‘you’re a good mother’ or ‘you’re doing a good job’ in a very long time,” she says. “We celebrate all the good they’re doing.”

Many came from poverty, from the foster-care system. Trauma, abuse and neglect figure largely in many of their life stories.

"We support them when they are at their lowest point, when everything is going wrong. When we believe that they can turn things around and achieve their goals, they start to believe it themselves,” Sarah Campbell says.

For the women who make progress, their pasts can be difficult to shake.

“One of the most interesting things we’ve seen is how difficult it can be to convince people who knew them before that they’ve changed,” Kate says. “They’ll warn us: ‘You don’t know her.’”

PCAP is a three-year program, which Kate says is key to its impact.

“The biggest thing is the importance of long-term support,” Kate says. “It can’t be a bandaid.”

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Building project knowledge

The PCAP team has learned a lot in its first year.

Dr. Gander says they over-estimated capacity. She’s concerned about burnout among the case managers, due to the heaviness and complexity of the clients’ needs.

“It is so labour-intensive,” she says. “You go on the emotional roller-coaster with them.”

They’ve adjusted the original PCAP model to local conditions. Saint John’s tenacious inter-generational poverty and ample supply of drugs create particular needs and challenges. The intake process sometimes needs to be adjusted around client capacity. More effort is being directed towards outreach and awareness among network partners.

And Dr. Gander says PCAP’s initial client roster is “a drop in the bucket” of the true number of mothers and mothers-to-be who need help. She wonders how many women who could benefit from the program are ineligible because they won’t disclose their drug use for fear of legal or social repercussions.

“Substance use is such a punitive, challenging thing,” she says. “Our clients are faced with negative stigma each and every day. It is very isolating, and makes them resistant to seeking help."

She sees trauma as the root cause of the difficult living circumstances faced by these families, largely due to their substance use.

“I’d love to see us evolving the program to any parent who has experienced toxic stress and trauma,” she says. “These people need case management, navigation and support. And they don’t have that.”

While the need is great, Dr. Gander says PCAP is already working.

“If you value a life, if you value even small, incremental change in a life, it’s a success.”